How HPV and Oral Cancer Are Linked

Cervical cancer is the most common disease related to human papillomavirus (HPV) worldwide—but that doesn't mean it's the only one. While it has been known for years that HPV is also associated with anal, penile, and vulvar cancers, scientists have recently found a strong link between HPV and oral cancers of the mouth and throat.

In fact, in the United States, oral cancers have passed cervical cancer as the most common malignancy caused by HPV.

Incidence

Worldwide, most mouth and throat cancers (also known as oropharyngeal cancer) are associated with tobacco and/or alcohol use. With the rapid rise in HPV infections in the United States—in which 79 million Americans are already believed infected, according to the 2014 National Health and Nutrition Examination Survey (NHANES)—oral cancers have come to the fore as another major public health risk.

In fact, a 2012 study in JAMA concluded that 10.1% of American men and 3.6% of American women have developed oral HPV. The risk is seen to increase in tandem with the number of sex partners a person has and the number of cigarettes smoked per day.

Sexual Risks

Anyone can get HPV-associated oral cancer but, for reasons not entirely clear, some people are at greater risk than others.

Overall, white men appear to be at the highest risk. Part of the reason for this may be that white American men are more likely to engage in oral sex than African American men.

According to a report in the journal Cancer Prevention Research, white males are 147% more likely to engage in oral sex on their first sexual encounter compared to their African American counterparts.

This is believed to contribute in part to a 20% increased risk of oropharyngeal cancers in white men.

Other risk factors include having more than five sexual partners within the past three months and starting sex in one's early adolescence or teen years.

By contrast, rates among women are lower due in part because of the lesser impact of HIV co-infection (which is exponentially higher in men). Women also tend to have half the number of lifetime sex partners than men, according to a 2018 study in the Journal of Sex Research.

Challenges in Testing

HPV is strongly associated with cancer of the tonsils, although it can be found in almost any part of the mouth or throat. Most are squamous cell carcinomas, the second most common skin cancer developing in the middle and outermost layers of skin.

Of the more than 150 strains of HPV identified by scientists, HPV 16 is the type most commonly linked to oral cancers. HPV 16 is also linked to cervical and penile cancer.

Part of the reason for the uncertainty is the limitations of the current HPV test. Although the DNA-based test can accurately detect HPV from a simple oral swab, having HPV (even high-risk HPV) does not mean you will get cancer.

A Word From Verywell

Given the limitations of the HPV testing, safer sex practices should be adhered to, including the consistent use of condoms and a reduction in the number of sex partners. HPV vaccination should also be strongly considered when appropriate.

In 2019, the Centers for Disease Control and Prevention (CDC) endorsed HPV vaccination for women and men 27 to 45 who are not adequately vaccinated. This guidance was an addition to their original recommendations that the vaccine can be given as early as 9 and through the age of 26.